Phil
We use the AKI management programme provided by our LIMS (Telepath) for Real time AKI detection of inpatients
We have used the rules based on the KDIGO guidelines
Stage Serum creatinine (SCr) criteria Urine output criteria
1 increase ≥ 26 μmol/L within 48hrs or
increase ≥1.5 to 1.9 X reference SCr <0.5 mL/kg/hr for > 6 consecutive hrs
2 increase ≥ 2 to 2.9 X reference SCr <0.5 mL/kg/ hr for > 12 hrs
3 increase ≥3 X reference SCr or <0.3 mL/kg/hr for
increase to 354 μmol/L or >24hrs or anuria for
commenced on renal replacement therapy 12hrs
(RRT) irrespective of stage
The reference serum creatinine should be the lowest creatinine value recorded within 3 months of the event
If a reference serum creatinine value is not available within 3 months and AKI is suspected we suggest repeating creatinine within 24hrs
For stage 1 only, we look for a reference creatinine within the last 7 days as recommended in the guidelines.
The programme only allows for one time window for a reference creatinine i.e. 7 days or 90 days so you can't specify it to look further if no result is available in 7 days.
The programme is able to identify the lowest creatinine in the last 90 days not just comparing the previous result.
Hope this helps
Richard Harris
Principal Biochemist
Kettering General Hospital
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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Phillip Monaghan
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Subject: AKI detection
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Dear colleagues,
We are currently liaising with our LIMS supplier (Technidata, TDLIMS) for real-time AKI detection. Has anyone had any good experience or advice on implementation of the rules based on the KDIGO guidelines that they would be willing to share?
Additionally, with regard to AKI stage 1, I seek clarification on 1) the absolute increase stipulated in the guidance is 26.5umol/L, are labs therefore using 26 or 27? 2) When exactly is the 90 day reference interval for a baseline creatinine applicable? Is this just for AKI stages 2 and 3, or can we look at previous 90 days for AKI stage 1 (≥1.5 to 1.9x baseline) if there isn’t a creatinine result from within the previous 7 days.
Furthermore, are LIS systems able to recognise the lowest (baseline) creatinine from within the previous 3 months, assuming that the previous creatinine result was not the baseline result?
All help and guidance gratefully appreciated.
Best wishes
Phil
___________________________________
Dr Phillip J Monaghan BSc MSc PhD
Principal Clinical Scientist
Department of Clinical Biochemistry
The Christie Hospital NHS Foundation Trust
Wilmslow Road
Withington
Manchester
M20 4BX
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